Nephrology Flashcards by Rithvik Rai

Sudden AKI, Urine Protenuria, Raised Serum and urine Esinophils,
Usually post Abx course ( usually penicillin)

What is your Dx

Acute tubulointerstitial Nephritis (TIN)/(ATIN)

Mx: Short course of steroids with PPI and Bone protection

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Middle age pt.
Fainting
Low K
Normal BP

urine Chloride >40 mmil

What is your Dx

Gitleman syndrome

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What are the common electrolyte associations with gitleman syndrome

Increase Urine Chloride >40 mmol
Hypocalciuria
Hypomagensemia
Hypokalaemia

Mx:
Mg and K replacement
If above failed, then K-sparing diuretics

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What is a key difference between IgA nephropathy and post-streptococcal GN

Ig A - Heamturia In 2-3 days of unwell/ URTI

Post strept - Few weeks after ( 2-3)

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In Hydronephrosis and pyelonephritis due to stone and fever

How would you Mx

1st line Mx: Uretrsocpy and stone removal
2nd - Percutaneous nephrostomy

Note: if Pt. is febrile and has possible pyelonephritis, Lithotripsy is Contraindicated as it can worsen sepsis and bacterial dissemination

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what is a key feature I urine analysis in Rahdbomylsis

Urine dip - Will show blood
But Microscopy will NOT show RBC

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what drugs can cause retroperitoneal fibrosis

Ergot derivatives such as as Beta blockers
Note:
Can also be due to Malignancy, sarcoidosis radiotherapy, Surgery

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> Lower limb oedema
Reduced urine output and worsening AKI
Normocytic anemia
Caludication
Vague lower back, abdominal pain

What is your Dx

retroperitoneal fibrosis

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Purpuric rash in teen
Worseing kidney function
Urine dip - Blood

What is your Dx

HSP

Note:
In microscopy you will see IgA and leucocytic vasculitis

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Sterile pyuria
Recurrent Negative urine culutres
Unwell
Loss of weight

What should you think of

Genito urinary TB
Send urine for TB culture

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HTN
Hypokalaemia
Alkalosis
Hyporenimic Hypoaldosternosim

What is your Dx

Liddle Syndome

Autosomal Dominant

M: Potasium sparing anti-HTN such as “ Amiloride”

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What is the Mx of Oxlalate stones

Increasing Urine Ph ( suppemental citrate and Mg)

Note:
Primary hyperoxaluria also has mild elevation in urince Ca and irate

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What is the 1st line Mx for pyelonehritis

Cefalexin

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Kimmelsietil-Wilson nodules are seen in which type of nephropathy

Diabetic nephropathy ( nephrotic type)

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Raised renin
Raised Aldosterone
HTN

What is the dx

Renal Artery Stenosis

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Low renin
Raised Aldosterone
HTN

What is the dx

Primary aldosteronism

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if Red cells show autonomic growth without eryhtropoetin

What does it mean

Primary Polycythemia
( independent of eryhtropoetin)

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Retinal/CNS tumours
risk of renal cell Ca
Polycythema
balance problems
HTN
Dizziness
Headaches
( high red ells, raised hematocrits, low plasma volume)

What is your Dx

Von-Hipple-Lindau

It also has associations with pheochromocytoma

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Post renal Transplant , sudden deterioration in Kidney fucntion in few months.

What is the most likely GN that recurs post Tx

Mebranoproliferative GN
(30-90%)

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In what kind of GN, do you see
+ve ANA and Low Complements

Lupus Nephritis

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What are the key features that will help you think of FSGN
( note: it is a nephrotic syndrome)

Black male
BG of obesity and HTN
Nephrotic syndrome features
“Profound Hypoalbunemia <20g/l)
Renal impairment

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What is the Hb and Ferritin targets in CKD

Ferritin >100

Hb : 100-120g/l

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Relapsing UTI’s
Fever, weight loss
Dull, persisten loin pain

CT : Heterogenous non enhancing mass in Kidney

Biopsy : Lipid laden macrophages with lympocytes and Polymorphnucler leucocytes

What is your dx

Xanthogranulomatous pyelonephritis
( Caused by proteus Mirabilis)

Common in diabetics and immunocmoporimised

MX: Nephrecomy

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How do you differentiate Uro-TB with Xanthogranulomatous pyelonephritis

Uro TB- will have sterile Pyuria

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What is the triad of Alport Syndrome

Nephritis Occular pathology Sensorineural Hearing Deafness NOTE: Need Electon Microscopy as Light Microscopy will be normal It is a type of Nephritic Syndrome

What do you see in ATN

>Raised Urine Na >Low to borderline normal Urine Omolality >Low urea to Creat ratio below 40:1 >Deranged Kindeny functions Causes: NSAID, Abx ( Vanc)

What is the Mx of Minimal Change GN

High Dose Prednisone 1mg/kg

Pt. on long term dialysis Gi upset Thenar weakness Carpal Tunnel Constirive pericarditis What is the cause

Excess accumulation of Beta2 microlglobulin causing feature of systemic amyloidosis Mx: >High flux biocompatible dialysis membranes >Renal Tx

Real Biopsy shows 'Cast Nephropathy' what is your Dx?

Myeloma Mx: Hematopoetic Stem Cell Tx

Renal Biopsy shows Thickening of basement memebrane and deposition of IgG and C3 what is your Dx

Membranous GN

Renal Biopsy shows Fusion of podocyte foot processes what is your Dx

Minimal change disease NOTE: This is on electron Microscopy Light microscopy will be normal

Renal Biopsy shows Crescent formation what is your Dx

Rapidly progressive GN

Renal Biopsy shows Kimmelsteil Wilson Lesions what is your Dx

Diabetic GN

Renal Biopsy shows Necrotising Granulomata what is your Dx

Pt. has Alport syndrome and ends up getting a renal Tx. Following few months, has worsening Kidney functions What Abs are likely to be re-activated

At risk of Anti-GBM disease reactivation

Pt. has Familial Medeterrainan Fever (FMF) What Rneal pathology are they at risk of in the long term

AA-type amyloid ( due FMF) IF taking long term analegesic/ NSAID - at risk of Analgesic nephropathy For both, Dx is Renal Biopsy

If Pt. is due for renal Tx, that is the safe level of Potassium Pre- Tx

K < 5.5 If K>5.5 , give another round of dialysis before Transplant.

When does acute rejection of renal Tx occur

first three Weeks from Tx IX: Renal Biopsy

What are the key features of ADPKD ( Autosomal Dominant Polycystic Kidney Disease)

Hematuria Loin Pain Abdo Mass HTN Associations: Intra cranial aneurysm SAH Hepatic cysts MVP Renal Stones

What is the triad of Renal Cell Ca

Flank pain Hematuria Abdo mass

Pt. on HAART Therapy with Atazanavir. What kidney complications can they have and how do you treat it

Worsening kdiney function "Crystal nephropathy" Mx: IV fluid hydration

Post PCI Deranged LFT's Levido Reticularis Eosinophilia What is your Dx

Cholesterol Embolism

What is the Mx of ANCA +ve GN

High Dose Prednisone + Cyclophopshamide If above fails, then Plasma Exchange

How can you confirm amylodosis

Abdominal subcutaneous fat biopsy or Rectal submucosal Biopsy Will be Congo red stain will show amyloid fibrils

What is the Mx of Lead poisoning

Penicillamine DMSA Calcium Disoidum Edetate

What is a thing to note about starting someone on Anti-HTN meds who are planning on pregnancy imminently

Anti-HTN meds can be teratogenic, ACE/ARB/ Thiazide like diuretics etc So caution should be taken and risk assessed based on severity of BP etc BP anyway falls a little in 1st trimester

How do you differentiate Gitelman syndrome from Bartters

Gitelman Slighly later stage of life Hypocalicuria Bartters In Childhood Will have Hypercalciruia

What is the inheritance of Alpert's

X-linked dominant

What are the causes of raised anion gap

Causes of Raised Anion Gap Metabolic Acidosis (AGMA) 🔹 Formula: Anion Gap= (Na+Cl) − (HCO3 +Cl) Normal AG: 8–12 mEq/L (≥12 is raised) Mnemonic: "MUDPILES" Cause Examples M – Methanol Toxic alcohol ingestion → formic acid U – Uremia Renal failure → impaired H+ excretion D – DKA Diabetes → ketone accumulation P – Paraldehyde Rare (old sedative use) I – Iron/Isoniazid Mitochondrial dysfunction → lactic acidosis L – Lactic Acidosis Sepsis, hypoxia, metformin, seizures E – Ethylene Glycol Antifreeze ingestion → oxalic acid S – Salicylates (Aspirin) Mixed respiratory alkalosis & AGMA 🔹 Lactic acidosis (Sepsis, Shock, Metformin, Hypoxia) is the most common cause.

What is the Mx of HUS

Supportive

What tubules are affected in RTA1 and RTA2

RTA1- Distal tubules RTA 2- Proximal tubules

What is the Tx for Cystinuria and stones of the same

1st- Alkalisation of the urine 2nd- Penicllamine

what is the Tx for calcium stones

Thiazide like diuretics

What do you use to Tx Urate Nephropathy

Allopurinol

Hyporeninic Hypoaldosternonism HTN Hypokalaemia

Liddles

Where do you see Phospholipase A2 receptor Antibodies

Membranous GN Also see spike and dome appearance on microscopy

SBP in someone having Peritoneal dialysis What is the cause and mx

Coag negative Staph Mx Intraperitoneal Vanc + gent

Basket Weave Appearance in renal biopsy What is the Dx

Alport Syndrome

What is the renal change/feature in Sarcoidosis

Granulomatous tubulointerstital Nephritis

What is the renal biopsy finding in Focal Proliferative GN

"Mesangial" Proliferation with +ve immunoflorence for IgA and C3 Note: In membranous GN ; it will be "Thickened Glomerular Basement membrane" with deposits of IgA and C3

if someone gets pregnant with pre-existing diabetic nephropathy and HTN What is the chance of HTN worsening ?

if baseline Creat <150 ( 16% chance) If baseline Creat 150-240 ( 20% chance) If Pt.has ESKD ( 45% chance )

What is the genetic mutation in Liddle syndrome

ENaC gain-of-function mutation ( inrcreases the uptake of Na form the collecting tubules in exchange for K)

What is the genetic mutation in Gittleman Syndrome

Sodium Chloride ( Na-Cl) Symporter mutation

What is the genetic mutation in Bartter Syndrome

Sodium-Potassium-Chloride (Na-K-2Cl) Channel

What are the common associations of FSGC ( it Is a neprhotic type of GN)

HIV, Hep B, IV Heroin use, Massive Obesity

'String of beads' appearance in renal angiogram. Pt.also has HTN What is the cause

Fibromuscular Dysplasia Mx: Angioplasty

What is the effective MX of diabetic Protenuria

ACE/ARB

Do you change to High Flux or Low flux Dialysis membranes in B-2 microglobulin deposition on Long term HD

High Flux

Which anti-arryhtmic drug can interact with ciclosporin and worsen its toxicity on renal TX Patients

Diltiazem ( metabolised by CYP3A4)

What should you think of the someonewiht HIV who has been started On HAART has sudden deterioration of Kidney functions

Crytal Uropathies / Nephrolithiasis ( Indiavir ) Check urine for crystals

How do you Tx Goodpasteurs ( Anti GBM)

Steroids and Plasma Exchange

What are some common associations of IgA Nephropathy

Coeliac and Cirrhosis

Recurrent UTI's as a child Now have deranged Kidney functions and high BP What is the dx

Reflux nephropathy note: there can also be scarring of Kdineys Urien dip : wil show WBC ++ Note: In pure hypertensive nephropathy Urine dip will Not show WBC

Rash, Esionopiils in urine, Deranged Kidneys, raised IgE post Abx or NSAID what is your Dx

Interstitial Nephritis

What are some the drugs that cause Interstitial Nephritis

>NSAIDs >Abx ( Pencillin, cephalosporine, quinolones, sulphonamides, rifampicin) >Allopurinol >Phenytoin

What is the difference between orthotopic and heterotopic

Orthotopic- Tx into same normal anatomical region Heterotopic- tx into different anatomical location Note: Autografts- same person Isografts - Same genetics ( twins) Allografts - Same species Xenografts - Different species

what are some key differences between acute prostatitis and chronic prostatitis

Both will have urianry symptoms BUT; Acute- Very tender on DRE Chronic - Mild tender on DRE Chronic - Has Painful Ejaculation Acute - NO painful ejaculation

What is the triad of Still;s disease

Persisten high fevers Joint pains Salmon coloured rash - characteristic

Why do you see pseudo hyponatremia in Nephrotic syndrome

Due to hyperlipidaemia

High urine Na Low to normal urine osmolality Deranged RFT's What is the dx

ATN ( acute Tubular Necrosis )

Where do you see "Brown Granular casts" in urine

ATN

What is the criteria for screening for intra cranial Aneurysm (ICA) in someone with ADPKD

> Family h/o of ICA or SAH >Personal prev H/o of ICA rupture > Pt. Anxiety > High risk job (Pilot)

What is the Mx of Conns and Liddles

Conns - Spironolactone Liddles - Amiloride

Sudden flash palm oedema ( can have pink frothy phlegm) HTN <50 years of age No obvious cardiac pathology What is the Dx

Fibromuscular dysplasia

What is a key diagnostic criteria for CKD from diabetic neprhopathy

Urine ACR >3mg/mmol for 3 months and/or Perisiten eGFR <60

What is the mechanism of Post Streptococcus GN

Immune complex deposition in glomeruli

What is the Mx of IgA Nephropathy

Steroids